If you breathe irregularly as you sleep, wake up gasping for breath, or feel excessively sleepy during the day, you may be experiencing symptoms of sleep apnea.
There are three types of sleep apnea. The most common type of sleep apnea is obstructive sleep apnea (OSA). OSA affects between 2% and 9% of adults1 in the United States and about 2% of children. If you have this respiratory disorder, your breathing is interrupted as you sleep. You might snore, gasp, choke, or snort during your sleep. These body responses may wake you from sleep.
Central sleep apnea (CSA) is a much rarer type of sleep apnea. The breathing difficulty isn’t from the airway itself but rather from the part of the brain that controls your breathing. A major symptom of CSA is a repeating cycle where your breathing gradually slows until you stop breathing altogether for a brief period. Mixed sleep apnea is a combination of OSA and CSA symptoms, though it typically presents as OSA first.
OSA causes symptoms like:
- snoring
- gasping for breath during sleep
- waking up many times during the night
If you are diagnosed with obstructive sleep apnea, your healthcare provider may recommend a continuous positive airway pressure (CPAP) machine for treatment. A CPAP machine gives you pressurized air as you sleep to ensure your airway stays open. Patients who use a CPAP machine consistently experience improved quality of life and reduced cognitive impairment. CPAP therapy may also reduce blood pressure.
People with OSA seek out CPAP alternatives for a number of reasons:
Cost: The machine’s out-of-pocket cost starts near $250 and can be up to $1,000 or more. If you use insurance to get a CPAP machine, you often are required to enroll in a rent-to-own plan with strict compliance requirements.
Compliance Requirements: Insurers such as Medicare require CPAP machine users to adhere to a 30-day compliance period4, using the machine at least 4 hours a night on 70% of nights. Patients may struggle to meet these requirements and feel it is an invasion of privacy.
Side Effects: Side effects vary among CPAP users. Some find the mask uncomfortable5 or experience dry mouth, red or itchy eyes, and a dry, stuffy, or runny nose. CPAP users and their sleeping partners may also be affected by noise caused by mask leaks. All of these side effects impact adherence.
Adherence: Adherence rates for CPAP machines may be as low as 50%
Common reasons for ditching a CPAP machine are that the device is clunky, uncomfortable, or noisy.
A number of lifestyle choices, devices, and surgeries can serve as alternative sleep apnea treatments for people who choose to not use a CPAP machine.
Treatments for sleep apnea
If CPAP isn’t for you, a few other OSA treatment options include:
- an oral appliance
- bilevel positive airway pressure (BiPAP)
- nasal valve therapy
- lifestyle changes, such as losing weight or quitting smoking
- surgery to fix an underlying cause of OSA
BiPAP machine
Another option is bilevel positive airway pressure (BiPAP) therapy. It’s similar to CPAP in that you wear a mask that pushes pressurized air into your airways to keep them open.
The difference is that with CPAP, the pressure is the same when you breathe in and out. People who use a CPAP may find the pressure hard to breathe out against.
A BiPAP machine has two pressure settings. It’s lower when you breathe out than when you breathe in. That lower pressure may make it easier for you to exhale, especially if you have trouble breathing because of heart or lung disease.
Oral appliances
An oral appliance is a less cumbersome alternative to CPAP. It looks similar to the mouthguard you’d wear while playing sports.
More than 100 different types of oral appliances are approved by the FDA to treat OSA. These devices move your lower jaw forward or hold your tongue in place. This helps prevent your tongue and the tissues of your upper airway from collapsing and blocking your airway while you sleep.
Oral appliances work best for people with mild to moderate OSA. They’re most effective when custom-fitted for you. Poorly fitting devices can cause jaw problems and may actually make sleep apnea worse.
A specialized dentist can fit you for the device and follow up with you to make sure that it’s helping your OSA.
Surgery
If devices and lifestyle changes haven’t improved your nighttime breathing, you might need surgery. Your doctor may recommend one of the following procedures, depending on the underlying problem that’s causing your OSA.
Genioglossus advancement. With this procedure, the surgeon cuts your lower jaw bone to move your tongue forward. The result holds your tongue in place so it doesn’t cover your airway.
Hypoglossal nerve stimulation. A device is implanted in your chest and connected to the hypoglossal nerve to control tongue movement. An attached sensor monitors your breathing while you sleep. If you stop breathing, the sensor stimulates the hypoglossal nerve to move your tongue out of your airway.
Jaw surgery. This type of surgery, referred to as maxillomandibular advancement, moves your upper jaw (maxilla) and lower jaw (mandible) forward to create more space for you to breathe.
Nasal surgery. Surgery can remove polyps or fix a deviated septum if one of these prevents you from breathing easily through your nose.
Soft palate implants. This less invasive option, also known as the pillar procedure, implants three small rods in the roof of your mouth. The implants prop up your soft palate to prevent it from collapsing over your upper airway.
Tongue reduction surgery. If you have a large tongue that blocks your airway, surgery can make it smaller.
Tonsil and adenoid removal. Your tonsils and adenoids sit in the back of your throat. If they’re so large that they block your airway, you may need to have them removed.
Uvulopalatopharyngoplasty (UPPP or UP3). A common surgical treatment for OSA, this procedure removes extra tissue from the back of your mouth and the top of your throat to let more air into your airway. An alternative is a uvulectomy, which removes all or part of the uvula, which is the teardrop-shaped tissue that hangs down at the back of your throat.
Weight loss
When you have overweight or obese, fat can settle around your neck and throat. During sleep, that extra tissue may block your airflow and cause sleep apnea.
Losing just 10 percent of your body weight can improve sleep apnea symptoms. It may even cure the condition.
Losing weight isn’t easy. With your doctor’s help, you can find the right combination of dietary changes and exercise techniques to make a difference with your OSA.
If diet and exercise aren’t enough to help you lose weight, you might be a candidate for bariatric surgery.
Lifestyle changes
These simple changes to your routine could help you sleep better at night:
Sleep on your side. This position makes it easier for air to get into your lungs.
Avoid alcohol. A few glasses of wine or beer before bed can relax your upper airway muscles and make it harder to breathe, which can interrupt your slumber.
Exercise often. Regular aerobic activity can help you lose the extra weight that makes it hard to breathe. Exercise can also help reduce the severity of sleep apnea.
Relieve congestion. Take a nasal decongestant or antihistamine to help open up your nasal passages if they’re clogged.
Don’t smoke. In addition to its other harmful effects on your health, cigarette smoking worsens OSA by increasing airway swelling.
CPAP is the standard treatment for OSA, but it’s not the only treatment. If you’ve tried a CPAP machine and it didn’t work for you, ask your doctor about other options.
Along with taking OSA treatment, try maintaining healthy habits. Losing weight, exercising regularly, and quitting smoking can all go a long way toward helping you get more restful sleep.
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